Abdominal wall punch

ABSTRACT

A surgical instrument to cut a clean defect in an abdominal wall needed for ileostomies and colostomies. The instrument has an &#39;&#39;&#39;&#39;L&#39;&#39;&#39;&#39; shaped body with a lower arm which is inserted through an incision and a circular cutter supported from an upper arm is pushed and turned through the tissue layers above the lower arm.

United States Patent r V 1 11 1 3,701,352

Bosworth 1 Oct. 31, 19 72 [54] ABDOMINAL WALL PUNCH 3,512,519 5/1970 Hall ..128/305 X Inventor: Nathaniel L- BOSWOl'fll, Fincastle Rd., Lexington, Ky. 40502 [22] Filed: Dec. 1, 19 70 21 Appl. No.: 94,012 Prim Examiner- Charming L. Pace Attorney-Stevens, Davis, Miller & Mosher 144,753 1 1952 Australia ..40s/9s [52] US. Cl. ..128/305, 83/188, 408/97 51 Im. Cl.....A6lb 17/32, 132311 21/14, B23b 49/00 [571 ABSTRACT [58] Field of Search ..s3/1ss; 408/95, 96, 97, 9s; A surgical imam, cut a clean defect in an at} 128,305 dominal wall needed for ileostomies and colostomies. Y The instrument has an L shaped body with a lower [56] References cued arm which is inserted through an incision and a circu- UNITED STATES PATENTS 1 lar cutter supported from an upper arm is pushed and turned through the tissue layers above the lower an'n. 2,050,709 8/1936 Lopez ..408/97 v 3,058,471 10/1962 Shope ..l28/305 9 Claims, 3 Drawing Figures I P'ATEN'TEDucm Ian 3.701.352

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INVENTOR NATHANIEL L. BOSWORTH ATTORNEYS PATENTEB sum 2 OF 2 m 2 a? /r i I Q. F p 2! 4:1 r u 0 in;

Ill fi a ili 1H a x 0 ABDOMINAL WALL PUNCH procedures, such a circular opening was usually made with a knife and scissors but it has been found exceedingly difficult to obtain a clean defect and to avoid independent displacement of various abdominal layers through which the hole may pass as well as to prevent conduit stenosis. It has also been found that use of the present invention leads to much less bleeding and much easier and quicker operative procedure.

An object of this invention is to provide a surgical instrument which is simple in construction and yet capable of cutting a clean precise opening through an abdominal wall with a minimum of bleeding.

A further object is to provide an instrument which will expedite surgical procedures and at the same time lessen the change of cicatricial stomal contractures.

Other objects and advantages of the present invention will become apparent upon a review of the accompanying drawings in which a preferred embodiment is illustrated by way of example and not limitation as follows:

FIG. 1 is a perspective view of thepresent instrument shown in place on an abdominal wall, the lower arm being under the wall;

FIG. 2 is an elevational view of the instrument of FIG. 1 partially in section with the cylindrical cutter shown in section and in the lowered position;

FIG. 3 is a perspective view of the instrument after the cylindrical cutter has been raised and the tissue core is being removed.

Referring now to the drawings in greater detail, a base member has a lower arm 12 and an upper arm 14, the upper arm being slidably mounted in member 10 and supporting an upstanding member 16 which holds a bearing support 18 at its upper end and an annular guide member 20 at its lower end. Through the bearing support 18 passes a shaft 22 which has a handle 24 at its upper end and a cylindrical cutter 26 at its lower end. The cylindrical cutter 26 is secured to the shaft 22' by an Allen set screw and has a highly sharpened edge 30 at its lower end and an open window 32 along one side of the body. The shaft 22 is supported for either axial or rotary movement within the bearing support 18 and may be secured in any pre-selected position by tightening knurled set screw 34. Similarly, the vertical position of upper arm 14 in relation to base member 10 may be adjusted by knurled set screw 36 as more clearly shown in FIG. 2.

The lower arm 12 has a depression 38 in which is removably placed a resilient disc 40 such as a circular piece of neoprene. The end 13 of the lower arm 12 may be detachably secured by means of screws 42 for convenience in replacement.

The cylindrical cutter is preferably sharpened by honing the inside edges 44 thereof as shown in FIG. 2. The body of the cylindrical cutter could be fashioned with a slightly larger diameter above the cutting edge so as to facilitate easy removal of the tissue plug as well as to insure the plug staying in position until after the cutter has been raised from its lowermost position.

In use, an incision is made adjacent and tangetial to the site of the desired circular opening and the lower arm 12 is inserted through that incision and maneuvered until it is approximately underthe desired location. The exact position is known from the annular guide plate 20 which remains on the outside of the skin. Knurledset screw 36 is then loosened and the entire upper arm is lowered until the guide plate 20 bears against the outside of the skin with a sufficient degree of tightness to hold the skin precisely in place, the tissue being somewhat compressed as shown in FIG. 2; the degree of compression varying with the resilient and fat thickness of the tissue. Knurled set screw 34 is then loosened and then with a quick, firm motion handle 24 is pressed down and turned so as to cut an opening through the tissue and seat the cutting edge 30 against the neoprene disc 40. The cutter is then withdrawn and the knurled set screw 34 onceagain tightened in order to hold the cutter in its up position so that the tissue core can be removed with a tweezers through window 32. The entire instrument can then be removed from the incision by loosening knurled set screw 36 and lifting upper arm 14.

The instrument is adaptable for any thickness of body wall, depending upon the height of member 10 but a maximum of six inches is usually sufficient. The

circular cutting punch can be made in any size but at present it is contemplated that three standard sizes, three-fourths inch, seven-eights inch and 1 inch would be available depending upon whether the instrument is used on a child or adult. The cutting cylinders are easily changed by simply loosening Allen set screw 28. p

The instrument can be made of any material which is easy to clean and readily sterilizable such as a surgical or stainless steel but the present invention is, of course,

not limited to any particular material and use of plastic is also contemplated.

The foregoing description of a preferred embodi ment is given by way of example only and it should be understood that the scope of the invention is defin only by the following claims.

What is claimed is: I 1. A surgical instrument for cutting a circular opening through an abdominal wall comprising:

a base having an upstanding arm and a lower arm adapted to be inserted in a surgical incision inan abdominal wall to underlie and support said wall;

an upper arm mounted on said. upstanding arm for movement toward and away from said'lower arm, said lower arm having a seat-forming means on its side facing the upper arm;

an elongated surgical punch assembly with means mounting it on said upper arm, said punch having a cylindrical cutter body presenting a cutting edge facing towards and aligned with said seat-forming means;

said means mounting said punch assembly on said upper arm providing for sliding and rotary movement to seat said cutting edge against said seatforming means so that an abdominal wall portion between said upper and lower arms is penetrated by said cutting edge to form a circular opening through said abdominal wall.

2. The instrument of claim 1 including a guide means positioned above said lower arm in alignment with said seat-forming means and said punch assembly so that when said lower arm is inserted through an incision the guide means is positioned on the skin above and outside the seat-forrning means for visually locating the site of the circular opening and holding the skin in position.

3. The instrument of claim 2 wherein the guide means is supported from said upper arm.

4'. The instrument of claim 2 in which the guide means is a flat annular plate.

5. The instrument of claim 2 in which said means mounting said punch assembly is a column mounted for movement parallel to said upstanding arm with said guiding means mounted at the lower end of the column and a vertically extending sleeve at the upper end of the column to slideably receive the punch assembly.

6. The instrument of claim 5 including stop means on the vertically extending sleeve to hold said punch assembly in a predetermined position.

7. The instrument of claim 1 wherein said cylindrical cutter body has an opening along one side thereof to facilitate removal of the cut tissue core.

8. The instrument of claim 1 including a resilient material as the surface of said seat-forming means.

9. The instrument of claim 1 in which the seat-forming means is a depression in said lower arm with a resilient'material in said depression. 

1. A surgical instrument for cutting a circular opening through an abdominal wall comprising: a base having an upstanding arm and a lower arm adapted to be inserted in a surgical incision in an abdominal wall to underlie and support said wall; an upper arm mounted on said upstanding arm for movement toward and away from said lower arm, said lower arm having a seatforming means on its side facing the upper arm; an elongated surgical punch assembly with means mounting it on said upper arm, said punch having a cylindrical cutter body presenting a cutting edge facing towards and aligned with said seat-forming means; said means mounting said punch assembly on said upper arm providing for sliding and rotary movement to seat said cutting edge against said seat-forming means so that an abdominal wall portion between said upper and lower arms is penetrated by said cutting edge to form a circular opening through said abdominal wall.
 2. The instrument of claim 1 including a guide means positioned above said lower arm in alignment with said seat-forming means and said punch assembly so that when said lower arm is inserted through an incision the guide means is positioned on the skin above and outside the seat-forming means for visually locating the site of the circular opening and holding the skin in position.
 3. The instrument of claim 2 wherein the guide means is supported from said upper arm.
 4. The instrument of claim 2 in which the guide means is a flat annular plate.
 5. The instrument of claim 2 in which said means mounting said punch assembly is a column mounted for movement parallel to said upstanding arm with said guiding means mounted at the lower end of the column and a vertically extending sleeve at the upper end of the column to slideably receive the punch assembly.
 6. The instrument of claim 5 including stop means on the vertically extending sleeve to hold said punch assembly in a predetermined position.
 7. The instrument of claim 1 wherein said cylindrical cutter body has an opening along one side thereof to facilitate removal of the cut tissue core.
 8. The instrument of claim 1 including a resilient material as the surface of said seat-forming means.
 9. The instrument of claim 1 in which the seat-forming means is a depression in said lower arm with a resilient material in said depression. 